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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To examine factors affecting survival after diagnosis of progressive multifocal leukoencephalopathy (PML), we analyzed data from an observational cohort study, the Adult and Adolescent Spectrum of HIV Disease project. We identified 415 patients diagnosed with PML during 1990-1997. The median survival time after diagnosis was 1 month. By use of an extended proportional hazards, multivariate regression model, risk factors associated with decreased survival time included CD4 count <0.20 x 10(9) cells/L (risk ratio [RR], 2.1; 95% confidence interval [CI], 1.3-3.5) compared with >/=0.20 x 10(9) cells/L, whereas factors associated with increased survival time were prescription of antiretroviral medication that contained a protease inhibitor (RR, 0.2; 95% CI, 0.1-0.4) and prescription of other antiretroviral medication (RR, 0.6; 95% CI, 0.5-0.8) compared with no antiretroviral prescription. We conclude that protease inhibitor use (in combination antiretroviral therapy) is likely to favorably affect survival time after diagnosis of PML.
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PMID:Progressive multifocal leukoencephalopathy: improved survival of human immunodeficiency virus-infected patients in the protease inhibitor era. 1043 48

To determine incidence and risk for preventable opportunistic infections (Pneumocystis carinii pneumonia [PCP] and disseminated Mycobacterium avium-complex [MAC] infection) in persons whose CD4(+) T lymphocyte counts had increased by >/=100 cells/microL to exceed the threshold of risk and in persons whose CD4(+) counts had never dropped below the threshold of risk, we analyzed data collected during the period 1990-1998 in the Adult/Adolescent Spectrum of HIV (Human Immunodeficiency Virus) Disease Project. Using a counting-process formulation of the Cox model, we analyzed observation time in these 2 groups for persons who were prescribed antiretroviral therapy but not prophylaxis. The incidences of the infections were low for patients whose CD4(+) count rose above the threshold of risk (PCP, 0.6 cases per 100 person-years [PY]; MAC, 1. 0 cases per 100 PY) and not higher than in persons whose CD4(+) counts had not decreased below these thresholds, which suggests that discontinuation of primary prophylaxis for opportunistic infections may be considered for some patients.
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PMID:Risk for preventable opportunistic infections in persons with AIDS after antiretroviral therapy increases CD4+ T lymphocyte counts above prophylaxis thresholds. 1091 98

To determine risk factors, seasonality, and trends of cryptosporidiosis among human immunodeficiency virus-positive (HIV+) patients in the New Orleans area, data from the New Orleans component of the Adult/Adolescent Spectrum of HIV Disease Study (ASD) were analyzed. A total of 6,913 HIV+ patients > or = 13 years of age were enrolled in the ASD database between 1990 and 1998. After an average follow-up of 42 months, cryptosporidiosis had been diagnosed in 239 patients (3.5%). The risk of developing cryptosporidiosis was higher among patients with CD4+ cell counts < 100 x 10(6)/L, among those who ever developed an acquired immunodeficiency syndrome (AIDS)-opportunistic illness, and among patients < 35 years old compared with their counterparts. A slight increase in cryptosporidiosis cases occurred in the spring compared with other seasons, but the difference was not statistically significant (P > 0.05). The prevalence of cryptosporidiosis increased from 2.9% (n = 7) in 1989 to 20% in 1994 (n = 48) before decreasing to 5.3% in 1998 (n = 14). Since a fair number of cryptosporidiosis cases are still being reported in the New Orleans area after the introduction of highly active antiretroviral therapy, further studies are needed to provide insight into the existence of potential environmental sources of Cryptosporidium.
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PMID:Risk factors, seasonality, and trends of cryptosporidiosis among patients infected with human immunodeficiency virus. 1103 82

To determine the factors associated with pneumococcal disease (pneumococcal pneumonia or invasive disease) and the impact of pneumococcal vaccine in HIV-infected persons, we analyzed patient data collected by the Adult and Adolescent Spectrum of HIV Disease Project for person-time between January 1990 and December 1998. Among 39,086 persons with 71,116 person-years (py) of observation, 585 episodes of pneumococcal disease were diagnosed (incidence, 8.2 episodes per 1000 py). Factors associated with an increased risk for pneumococcal disease (P < .05) included injection drug use (adjusted relative risk [RR], 1.5) and blood transfusion (RR, 2.0) as the mode of HIV transmission (referent, male-male sex); black race/ethnicity (RR, 1.5; referent, white race); history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic illness (RR, 2.1); a CD4(+) cell count of 200-499 cells/microL (RR, 2.5) or < 200 cells/microL (RR, 3.7; referent, CD4(+) cell count of > or = 500 cells/microL); and alcoholism (RR, 2.0). Factors associated with a decreased risk included prescription of antiretroviral therapy (RR for monotherapy, 0.6; for dual therapy, 0.7; for triple therapy, 0.5) and pneumococcal vaccination (RR for persons vaccinated at a CD4(+) cell count of > or = 500 cells/microL, 0.5). We recommend that pneumococcal vaccine be given to HIV-infected persons before profound immunosuppression has occurred.
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PMID:Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. 1122 48

To examine survival after diagnosis of Pneumocystis carinii pneumonia (PCP) and factors associated with early death (during the month of or the month after diagnosis of PCP), data were analyzed from the Adult and Adolescent Spectrum HIV Disease project. Among 4412 patients with 5222 episodes of PCP during follow-up (1992-1998), survival at >1 month after diagnosis was 82%, and survival at > or =12 months after diagnosis was 47%; 12-month survival increased from 40% in 1992-1993 to 63% in 1996-1998. By multiple logistic regression analysis, early death was associated with history of PCP (odds ratio [OR], 1.4), age 45-59 years (OR, 1.9) or > or =60 years (OR, 3.7), and CD4 cell count of 0-24 cells/microL (< or =5 months before PCP; OR, 1.8) or 25-49 cells/microL (OR, 1.4) (P<.05). Concurrent prescription of combination antiretroviral therapy (OR, 0.2) and other antiretroviral therapy (OR, 0.4) was associated with surviving the early period. This study shows improved survival after diagnosis of PCP in recent years, despite emergence of antibiotic-resistant mutant P. carinii strains.
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PMID:Survival of patients with AIDS, after diagnosis of Pneumocystis carinii pneumonia, in the United States. 1129 75

Two reports submitted at the Second National Conference on Human Retroviruses reignited the controversy surrounding acyclovir's potential effect on survival in HIV-infected persons. One study found no differences in survival between those using acyclovir and those not using the drug, however, it is argued that the study did not take into account duration and continuity of acyclovir use, nor did it consider that acyclovir users were likely to have had lower CD4 counts than the nonusers. The second study involved acyclovir in combination with AZT, which also revealed no survival benefit. Large numbers of subjects withdrew, making results difficult to interpret. Also, the exclusion of people needing chronic acyclovir for suppression of frequent herpes outbreaks may have removed exactly the group in whom acyclovir would most likely extend survival. To resolve the issue, there is a need for large-scale trials with sufficient statistical power and a particular subpopulation of people with HIV who might gain the most benefit from acyclovir. Two observational studies, one utilizing the CPCRA's 5,000-person database, and the other looking at the 6,000 patients enrolled in the Adult Spectrum of Disease cohort based in Atlanta, are continuing to investigate the relationship between acyclovir and survival.
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PMID:Acyclovir controversy. 1136 65

Trimethoprim-sulfamethoxazole (TMP-SMZ) is widely prescribed as prophylaxis for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected persons. Its efficacy against other infections has not been thoroughly evaluated. To compare the risk for infectious diseases for persons who were prescribed TMP-SMZ with that for patients who were not prescribed TMP-SMZ, we examined data collected from the medical records of HIV-infected patients (January 1990 through September 1999) who were enrolled in the Adult and Adolescent Spectrum of HIV Disease Project. During intervals when patients had CD4(+) T lymphocyte counts of <200 cells/microL (19,081 persons; 22,801 person-years), prescription of TMP-SMZ was associated with significant protection from toxoplasmosis, salmonellosis, infection with Haemophilus species, invasive or any staphylococcal infection, and PCP, but not from Shigella, pneumococcal or nonpneumococcal Streptococcus, Klebsiella, or Pseudomonas species. We demonstrate that prescription of TMP-SMZ for PCP prophylaxis in persons with HIV infection is associated with significantly decreased risk for several infectious diseases. These findings may be of interest to HIV prevention programs in resource-poor countries.
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PMID:Prophylaxis with trimethoprim-sulfamethoxazole for human immunodeficiency virus-infected patients: impact on risk for infectious diseases. 1143 10

The purpose of this study was to determine if HIV+ persons who first obtained health care in New Orleans through public hospital inpatient services had a higher risk of death or disease progression than patients who first entered care through public outpatient services. The sites included the largest HIV outpatient clinic in the Gulf South, two early intervention sites and a public hospital. A medical record review on patients who attended these sites from July 1995 through December 1999 and were enrolled in the Adult Spectrum of Disease (ASD) Study was conducted (n = 3402). The multivariate analysis examined the associations between inpatient services and the main effects. Kaplan-Meier analysis and Cox proportional hazards regression were performed. Risk of death or disease progression was analyzed for three different endpoints: time from study entry to death, time from HIV to AIDS, and time from AIDS to death. The multivariate analysis showed that patients first entering care through inpatient services were significantly more likely to be African American, have AIDS, and use drugs. The risk of death or disease progression was significantly higher for all three endpoints. Results from this study indicate that HIV+ individuals receiving initial care through public hospital inpatient services may require more effective early intervention.
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PMID:Survival patterns among HIV+ individuals based on health care utilization. 1144 93

Clinically significant interactions occurring during antituberculous chemotherapy principally involve rifampicin (rifampin), isoniazid and the fluoroquinolones. Such interactions between the antituberculous drugs and coadministered agents are definitely much more important than among antituberculous drugs themselves. These can be associated with consequences even amounting to therapeutic failure or toxicity. Most of the interactions are pharmacokinetic rather than pharmacodynamic in nature. The cytochrome P450 isoform enzymes are responsible for many interactions (especially those involving rifampicin and isoniazid) during drug biotransformation (metabolism) in the liver and/or intestine. Generally, rifampicin is an enzyme inducer and isoniazid acts as an inhibitor. The agents interacting significantly with rifampicin include anticoagulants, anticonvulsants, anti-infectives, cardiovascular therapeutics, contraceptives, glucocorticoids, immunosuppressants, psychotropics, sulphonylureas and theophyllines. Isoniazid interacts principally with anticonvulsants, theophylline, benzodiapines, paracetamol (acetaminophen) and some food. Fluoroquinolones can have absorption disturbance due to a variety of agents, especially the metal cations. Other important interactions of fluoroquinolones result from their enzyme inhibiting potential or pharmacodynamic mechanisms. Geriatric and immunocompromised patients are particularly at risk of drug interactions during treatment of their tuberculosis. Among the latter, patients who are HIV infected constitute the most important group. This is largely because of the advent of new antiretroviral agents such as the HIV protease inhibitors and the non-nucleoside reverse transcriptase inhibitors in the armamenterium of therapy. Compounding the complexity of drug interactions, underlying medical diseases per se may also contribute to or aggravate the scenario. It is imperative for clinicians to be on the alert when treating tuberculosis in patients with difficult co-morbidity requiring polypharmacy. With advancement of knowledge and expertise, it is hoped that therapeutic drug monitoring as a new paradigm of care can enable better management of these drug interactions.
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PMID:Clinically significant interactions with drugs used in the treatment of tuberculosis. 1188 53

Selected plants used in Rwandan traditional medicine for the treatment of infections and/or rheumatoid diseases were investigated for antiviral activity in vitro against human immunodeficiency virus type-1 (HIV-1). Of the 38 tested 80% ethanolic extracts, belonging to plants of 21 different families only the extracts from the leaves of Aspilia pluriseta (Asteraceae) and Rumex bequaertii (Polygonaceae) had interesting selectivity indices (SI = ratio of the 50% cytotoxic concentration to the 50% effective antiviral concentration) higher than 1. Further fractionation of the initially antivirally inactive ethanolic extract of Tithonia diversifolia, however, led to an aqueous fraction with a high anti-HIV-1 activity (SI > 461), indicating that the cytotoxicity of some plant components may mask the antiviral properties of the active plant substances in total plant extracts.
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PMID:Antiviral activity of Rwandan medicinal plants against human immunodeficiency virus type-1 (HIV-1). 1192 66


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